SCOT-PEP statement on PrEP

SCOT-PEP statement on PrEP
 
SCOT-PEP is keen that women (cis and trans), sex workers, and other affected groups such as drug users be included in the conversation about PrEP. While we obviously want affected communities to have access to any and all healthcare that can help tackle HIV, we're hearing concerns and ambivalence among sex workers regarding PrEP – concerns which haven't been reflected in the national discussion around this issue. 
 
These concerns included worries that the mainstreaming of PrEP to sex workers, unless accompanied by the full decriminalisation of sex work, could reduce sex workers' power to negotiate condom use in interactions with clients and managers. (Full decriminalisation would somewhat allay these fears as it would increase sex workers power in this area.) Furthermore, sex workers were concerned that this medication would be withheld from them by the police in the event of arrest, limiting its effectiveness. Sex workers were worried that where we're on hormonal contraception, are trans, are drug using, or are any combination of these three factors, that insufficient information has been made accessible to us in terms of how synthetic hormones or other drugs could interact with PrEP. Sex workers were worried that we don't know what's involved in the assessment of PrEP by medical professionals: will people be required to disclose fitting within a 'risk' category or otherwise be expected to 'out' themselves in order to have access to PrEP? And who has access to this information?
 
Finally, there was huge concern that PrEP will be offered to sex workers instead of full decriminalisation, which is the measure that would most meaningfully allow us to claim our rights and safety and to access healthcare. Overwhelmingly, it is criminalisation that makes us vulnerable to HIV, violence, and exploitation – and PrEP risks being an inadequate technological 'sticking plaster' or quick-fix for this structural problem. If we're talking about sex work, HIV, and healthcare, the key fact is that sex workers need decriminalisation, now.